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Pre-Transplant Evaluation

Patients must have advanced liver failure to be candidates for liver transplant. Once the Lourdes transplant team confirms this status and verifies insurance coverage, the staff can schedule patients for a transplant evaluation.

The purpose of the liver transplant evaluation is to first identify the cause of the underlying liver disease, determine the severity of the condition and the patient’s likely survival time, and consider the significance of any co-morbid medical, surgical or psychiatric conditions that might impact the surgical outcomes. This is achieved through evaluation of the patient’s medical, social, psychological, financial conditions, and social support system.   During the transplant evaluation, patients meet with the Lourdes liver transplant team, which consists of a hepatologist, transplant surgeon, social worker, pre- transplant nurse coordinator, financial coordinator, dietitian, and a transplant pharmacist.

The team’s pre-transplant nurse coordinator is responsible for educating the patient about his/her rights and the risks and benefits of transplantation.   The nurse conducts the initial education session with the patient during the evaluation and includes discussion of:

  • the selection criteria
  • the evaluation process
  • evaluation testing
  • psychosocial factors
  • nutritional considerations.

The team’s financial coordinator reviews financial aspects of transplantation with the patient during the evaluation phase including coverage provided by his/her insurance. The center’s social worker performs a psychosocial evaluation and the dietitian a nutritional assessment.

In addition to a team evaluation, candidates have a variety of medical testing and consultations to assess medical suitability for transplant. The common tests and evaluations performed during the evaluation are listed below.

Once the evaluation and planned medical testing and consultations are completed, the team brings each potential candidate’s information and results to the weekly multidisciplinary liver transplant team meeting to determine suitability for transplant.   If deemed suitable, patients are placed on the wait list.

Prior to listing the patient on the waitlist, a surgical family meeting is scheduled and the transplant surgeon meets with the patient, medical power of attorney, and family members to review considerations, including:

  • the transplant process and surgery
  • risks and benefits of transplantation
  • possible complications and risks
  • organ donor risk factors
  • immunosuppressive medications
  • alternative treatments
  • organ allocation — MELD scoring
  • multiple listing
  • the right to refuse transplantation
  • Lourdes transplant registry outcomes
  • notification about all Medicare requirements not being met by the transplant center
  • impact on medication payment if transplanted in a non-Medicare approved transplant center.

Recognizing that the evaluation process can be overwhelming for some, the team encourages the patient to bring his or her loved ones or support person (as well as any potential kidney donors) to the visit.

Liver transplant patients will also have a variety of blood tests drawn the day of evaluation to confirm blood type and test for various viruses and diseases.   The staff will assess the patient (and/or donor’s) overall health in preparation for liver transplant surgery.

The team will formulate a plan for medical testing, consultations and follow-up of any concerns discovered during the evaluation.   In many instances, patients may have already had some of these tests and consultations completed due to previous hospitalizations or health concerns.   In that case, the team endeavors to obtain copies of those records and review them.

Patients already listed at another transplant center must still undergo evaluation by the Lourdes kidney/pancreas transplant team, even as records are obtained from the other transplant centers.   Please see below a list of the common testing ordered as part of liver transplant evaluation:

  • a variety of blood tests some (checking blood count, clotting factors, and liver function for first MELD score)
  • MR or CT imaging of the abdomen
  • chest X-ray
  • echocardiogram to check for abnormalities in the heart, its valves or blood flow through it.
  • stress test and if necessary, a catheterization and angiogram, to exam blood flow through the liver, heart and other blood vessels
  • endoscopy to detect any bleeding or enlarged blood vessels in the gastrointestinal tract
  • colonoscopy to check for any pre-cancerous polyps
  • liver biopsy to determine status and disease state of liver tissue
  • ultrasound to check for obstructions or tumors in the liver
  • skin test for exposure to tuberculosis
  • dental check-up to screen for periodontal infection.
  • GYN exam and Pap smear for females if more than one year since these tests
  • mammogram for females older than 40 if more than one year since this test
  • PSA test for males
  • pulmonary function test, including arterial blood gas at room air.

Patients’ vaccinations must also be brought up to date.

Additional testing for transplantation may be required based on the initial evaluation, history and physical exam or results of testing.

Candidates must meet these criteria for liver transplant:

  • physical incapacitation causing deterioration of health or  the quality of llfe to an unacceptable level due to documented, isolated chronic or acute liver disease
  • a limited life expectancy (typically less than two years) due to liver dysfunction
  • unsuccessful treatment with previous optimal medical therapy and no therapy other than transplantation offers realistic expectation of hepatic functional improvement and extension of life.

While many factors determine who is better suited for this operation, the best candidates for liver transplant are patients with:

  • adequate function in the heart, lung and other organs
  • a reasonable body mass index not indicative of severe obesity
  • absence of active infections, malignancies or other major conditions
  • ability to undergo major surgery and tolerate post-transplant medications
  • a strong record of self-care and compliance with their medical regimen, as well as an adequate circle of support and system of and services and care
  • the medical coverage necessary to pay for a life-long course of immunosuppressive drugs needed after surgery, or supplemental sources of coverage for these medications
  • and absence of drug and alcohol use.

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